Blacks bear a disproportionate burden of asthma morbidity and mortality. In its 2005 report on ethnic disparities in health care, AHRQ identified hospital admissions for asthma as the second largest disparity in quality of health care for Blacks versus Whites. The BELT study (Blacks and Exacerbations on LABA vs. Tiotropium; 1R01HS019408- 01) was funded through AHRQ to compare the effectiveness of long-acting beta agonists (LABA)/inhaled corticosteroids (ICS) vs. Tiotropium/ICS in delaying the time to exacerbation in Black patients with asthma. This study enrolled >1000 subjects at 18 sites across the United States and followed them for at least 6 months and up to 18 months, while collecting robust asthma outcome data. To extend the usefulness and sustainability of the BELT study cohort dataset, the PESBART study is proposed. The objective of this proposal is to collect geographic environmental and stress data and to utilize a stakeholder engagement process over an 18-month period to develop new comparative effectiveness research questions and to enhance the current data infrastructure as relevant to the BELT cohort. The specific aims of this project are to: 1) increase the utility of the BELT data infrastructure by collecting geographic information on the environmental and stress exposures that may be associated with asthma outcomes; 2) preprocess the genotype data generated on a majority of BELT subjects in preparation for subsequent genetic analyses; 3) enhance sustainability and relevance of the BELT data infrastructure by involving a team of stakeholders with expertise in areas of environmental epidemiology, population genetics, clinical practice and patient advocacy; and 4) perform a Pilot study that will assess the completeness and accuracy of the geographic data elements and its ability to answer the research questions proposed by the PESBART Stakeholders. Understanding the interaction of environmental exposure, stress, and genetic determinants in contributing to asthma severity are important to individuals making decisions about where to live, policy makers in making decisions about locations for housing developments and other urban planning issues, and physicians interested in utilizing personalized treatment paradigms.